P1582: A COMPARISON OF TRANSFUSION REACTIONS BETWEEN PRESTORAGE AND POSTSTORAGE LEUKOREDUCED APHERESIS PLATELETS: A PROPENSITY-SCORE MATCHING ANALYSIS
Authors: Sheng-Hsuan Chien, Yu-Chen Tsai, Shu-Hua Lu, Ying-Ju Chen, Wen-Chun Chen, Chun-Yu Liu
Journal: HemaSphere (2023)

Topic: 31. Transfusion medicine Background: Transfusion reaction is a major issue in transfusion medicine. Platelets transfusion can be accompanied by adverse reaction and these reactions could be alleviated by leukocyte reduction in platelets. Leukoreduction of apheresis platelets can be performed either pre-storage or post-storage. Pre-storage leukoreduction is generally believed to be superior to post-storage leukoreduction in preventing transfusion reactions because the former method reduces cytokine release from leukocytes while the platelet product is in storage. However, few studies have compared these two modalities of transfusion reaction prevention, especially for apheresis platelet Aims: We conducted a retrospective study to compare the transfusion reactions between pre-storage and post-storage leukoreduced apheresis platelets by using a propensity-score-matching analysis. Methods: We retrospectively reviewed all leukoreduced apheresis platelet transfusion orders for inpatients in Taipei Veterans General Hospital from August 2018 to December 2022. Data on each patient's age, sex, blood type, admission ward, transfusion reaction, symptoms and categories were obtained for analysis. Logistic regression was used to determine the association between transfusion reactions and both pre-storage and post-storage leukoreduced apheresis platelets. A multivariate analysis adjusted for sex, age, and other clinical variables was performed to investigate the association between transfusion reactions and leukocyte-reduced apheresis platelets. Propensity-score matching was performed to adjust for baseline differences between the pre-storage and post-storage groups. Logistic regression results are presented as odds ratio as well as 95% confidence interval (CI), and results were considered significant at P < 0.05. Results: A total of 116 transfusion reactions were reported among 21,884 pre-storage leukoreduced apheresis platelet transfusions, and 174 reactions were reported among 18,953 post-storage leukoreduced transfusions. In the crude analysis, the odds ratio determined by the logistic regression for transfusion reactions in pre-storage relative to post-storage leukoreduction was 0.575 (95% CI 0.454–0.728, P<0.01). Multivariate analysis adjusted for sex, age, and other covariates revealed an odds ratio of 0.572 (95% CI 0.450–0.725, P<0.001). In the propensity-score matching cohort, a total of 18,314 transfusion orders were paired in pre-storage and post-storage. The conditional logistic regression after propensity-score matching showed an odds ratio of 0.631 (95% CI 0.493–0.808, P< 0.001). Regarding the transfusion reaction related symptoms, both unmatched and propensity-score matched cohort showed pre-storage leukoreduction significantly decreases the symptoms of chills, fever, itching, urticaria, dyspnea, and hypertension as compared with those in post-storage leukoreductions. In transfusion reaction categories, pre-storage leukoreduction significantly decrease febrile non-hemolytic transfusion reaction (FNHTR) and allergic reactions. Summary/Conclusion: This study suggests pre-storage leukoreduction apheresis platelet significantly decreases the transfusion reaction as compared with those in post-storage leukoreductions, especially in FNHTR and allergic reactions. The crude rate of transfusion reactions for pre-storage and post-storage leukoreduction groups was 0.53% and 0.91%, respectively. The number needed to treat to avoid one transfusion reaction with pre-storage rather than post-storage leukoreduced platelets was 263. A cost-effective analysis may be considered when implementing pre-storage or post-storage apheresis platelet transfusions.Keywords: Blood transfusion, Platelet transfusion, Apheresis